This is the title used for a diverse group of health-related therapies and disciplines which are not considered to be a part of mainstream medical care. Other terms sometimes used to describe them include ‘natural medicine’, ‘nonconventional medicine’ and ‘holistic medicine’. CAM embraces those therapies which may either be provided alongside conventional medicine (complementary) or which may, in the view of their practitioners, act as a substitute for it. Alternative disciplines purport to provide diagnostic information as well as oﬀering therapy. However, there is a move now to integrate CAM with orthodox medicine and this view is supported by the Foundation for Integrated Medicine in the UK in its report, A way forward for the next ﬁve years? – A discussion paper (1997).
The University of Exeter Centre for Complementary Health Studies report, published in 2000, estimated that there are probably more than 60,000 practitioners of complementary and alternative medicine in the UK. In addition there are about 9,300 therapist members of organisations representing practitioners who have statutory qualiﬁcations, including doctors, nurses (see NURSING), midwives, osteopaths and physiotherapists; chiropractors became fully regulated by statute in June 2001. There are likely to be many thousands more health staﬀ with an active interest or involvement in the practice of complementary medicine – for example, the 10,000 members of the Royal College of Nursing’s Complementary Therapy Forum. It is possible that up to 20,000 statutory health professionals regularly practise some form of complementary medicine including half of all general practices providing access to CAMs – most commonly manipulation therapies. The report from the Centre at Exeter University estimates that up to 5 million patients consulted a practitioner specialising in complementary and alternative medicine in 1999. Surveys of users of complementary and alternative practitioners show a relatively high satisfaction rating and it is likely that many patients will go on to use such therapists over an extended period. The Exeter Centre estimates that, with the increments of the last two years, up to 15–20 million people, possibly 33 per cent of the population of the country, have now sought such treatment.
The 1998 meeting of the British Medical Association (BMA) agreed to ‘investigate the scientiﬁc basis and eﬃcacy of acupuncture and the quality of training and standards of conﬁdence in its practitioners’. In the resulting report (July 2000) the BMA recommended that guidelines on CAM use for general practitioners, complementary medicine practitioners and patients were urgently needed, and that the Department of Health should select key CAM therapies, including acupuncture, for appraisal by the National Institute for Clinical Medicine (NICE). The BMA also reiterated its earlier recommendation that the main CAM therapies, including acupuncture, should be included in familiarisation courses on CAM provided within medical schools, and that accredited postgraduate education should be provided to inform GPs and other clinicians about the possible beneﬁts of CAM for patients.